The Accident Hospital Benefit Explained
Pays for hospital expenses related to an accident
Hospital Cover for Accident Events
Accidents happen, you don't plan for them but you can get a health insurance plan that helps cover private hospital costs related to an accident.
It even includes rehabilitation treatment, emergency services and casualty cover.
Choose Your Level of Cover
Flexible levels of cover mean you get to build your plan to suit your needs and budget.
Level 1
Single Policies
- R75,000 per event
- R150,000 per year
- R2,000 per event for rehabilitation treatment
Family Policies
- R150,000 per event
- R300,000 per year
- R5,000 per event for rehabilitation treatment
Level 2
Includes all Level 1 benefits with the following upgrades:
Single Policies
- R125,000 per event
- R250,000 per year
Family Policies
- R250,000 per event
- R500,000 per year
Level 3
Includes all Level 1 benefits with the following upgrades:
Single Policies
- R200,000 per event
- R400,000 per year
Family Policies
- R400,000 per event
- R800,000 per year
How Does It Work?
Find answers to the most common questions about this benefit. Browse our Help pages and Blog posts for more information.
What is covered?
All hospital costs related to an accident event are covered within your chosen benefit limits. This includes doctors and radiology like MRI and CT scans.
It is limited to the stated amounts (per event or per year) in your chosen benefit level. You are not limited to a specific number of days in hospital, only the benefit amounts chosen.
Also included:
- The Rehabilitation Treatment cover amounts can be used to pay for medical costs related to the accident after you have left the hospital. This is available up to 12 months after the event.
- 24/7 Emergency Services for rapid response and transport to a hospital.
How does this relate to Accident Casualty cover?
The Accident Casualty benefit offers R15,000 per member per year when:
- you go to hospital as a result of an accident
- you get treated in the emergency casualty room
- instead of being admitted to the hospital
If you are admitted to hospital then the Accident Hospitalisation benefit applies.
What is the waiting period?
Accident cover has no waiting period. Your cover will be available immediately when your policy is active.
What is an Accident Event?
To quote the policy wording:
- "A sudden, unforeseen, unusual and unexpected specific event" - an accident
- "which is unintended" - you didn't mean it to happen and it was not self-inflicted
- "arises from a source external to the insured" - it was something else that affected you, like a car or a spider
- "which is independent of illness, disease or other bodily malfunction" - illnesses are not accidents
- "occurs at an identifiable time and place" - you can pinpoint what it was and when it happened
The definition above helps because it is not only car accidents that apply but also falling, getting bitten by a dog, malaria or other accidental events. But getting cancer is not an accident, even though it was not intended.
Is authorisation required?
Accidents may require immediate hospitalisation or result in the injured person being unconscious or otherwise unable to obtain pre-authorisation.
Medical personal will always stabilise a patient before being admitted, at which point your next of kin can assist with identifying you and your available medical cover.
If you can't practically pre-authorise a hospital visit owing to an accident then you must inform EssentialMED within 48 hours about the accident event.
The authorisation procedure is described on the Claims page.
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